Reinnervating the Penis in Spina Bifida Patients in the United States: Ilioinguinal-to-Dorsal-Penile Neurorrhaphy in Two Cases

Micah A. Jacobs, Anthony M. Avellino, David Shurtleff, Thomas S. Lendvay

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Introduction: Penile sensation is absent in some patients with myelomeningocele owing to the dysfunction of the pudendal nerve. Here, we describe the introduction of penile sensation via ilioinguinal-to-dorsal-penile neurorrhaphy in two patients with penile anesthesia due to neural tube defects. Aim: To establish penile sensation via ilioinguinal-to-dorsal-penile-nerve neurorrhaphy. Methods: A 20-year-old and a 35-year-old male with L5/S1 myelomeningocele were both highly functioning and ambulatory, with intact ilioinguinal nerve distribution sensation but anesthesia of the penis and glans. They were sexually active and able to ejaculate antegrade. Both had high International Index of Erectile Function scores for confidence to achieve erection sufficient for intercourse. An incision was made from anterior superior iliac crest to the glans penis to expose the inguinal canal and ilioinguinal nerve. The ilioinguinal and dorsal penile nerve were transected and anastomosed. The anastomotic site was then wrapped in a hemostatic agent and a drain was left in place. For penile rehabilitation, both patients were instructed to stimulate the penis while looking at the genitalia to encourage redistribution of perceived sensation. Main Outcome Measures: Presence of erogenous penile sensation was tested by neurologic examination and patient feedback, and patients completed sexual health questionnaires. Results: Both patients reported paresthesias of the groin with penile stimulation 1 month after surgery. Both patients are now 24 months postoperative and have erogenous sensation on the ipsilateral glans and shaft during intercourse. Neither patient has difficulty achieving or maintaining erections. Conclusions: We present two patients with dorsal penile reinnervation via the ilioinguinal nerve. Although nerve reinnervation has been used in urological procedures, this is the first description of an attempt to resupply penile sensation via the dorsal penile nerve in the United States with a minimum of 18 months follow-up. Early follow-up suggests successful neuronal remapping and regained sensation of the penis.

Original languageEnglish (US)
Pages (from-to)2593-2597
Number of pages5
JournalJournal of Sexual Medicine
Volume10
Issue number10
DOIs
StatePublished - 2013

Fingerprint

Spinal Dysraphism
Penis
Pudendal Nerve
Meningomyelocele
Anesthesia
Inguinal Canal
Genitalia
Neural Tube Defects
Groin
Paresthesia
Reproductive Health
Neurologic Examination
Hemostatics
Rehabilitation
Outcome Assessment (Health Care)

Keywords

  • Genital Sensation
  • Ilioinguinal Nerve
  • Reinnervation
  • Spina Bifida
  • Spinal Cord Injury

ASJC Scopus subject areas

  • Urology
  • Obstetrics and Gynecology
  • Reproductive Medicine

Cite this

Reinnervating the Penis in Spina Bifida Patients in the United States : Ilioinguinal-to-Dorsal-Penile Neurorrhaphy in Two Cases. / Jacobs, Micah A.; Avellino, Anthony M.; Shurtleff, David; Lendvay, Thomas S.

In: Journal of Sexual Medicine, Vol. 10, No. 10, 2013, p. 2593-2597.

Research output: Contribution to journalArticle

@article{6623d35b28c74a95b8eb255b23de618b,
title = "Reinnervating the Penis in Spina Bifida Patients in the United States: Ilioinguinal-to-Dorsal-Penile Neurorrhaphy in Two Cases",
abstract = "Introduction: Penile sensation is absent in some patients with myelomeningocele owing to the dysfunction of the pudendal nerve. Here, we describe the introduction of penile sensation via ilioinguinal-to-dorsal-penile neurorrhaphy in two patients with penile anesthesia due to neural tube defects. Aim: To establish penile sensation via ilioinguinal-to-dorsal-penile-nerve neurorrhaphy. Methods: A 20-year-old and a 35-year-old male with L5/S1 myelomeningocele were both highly functioning and ambulatory, with intact ilioinguinal nerve distribution sensation but anesthesia of the penis and glans. They were sexually active and able to ejaculate antegrade. Both had high International Index of Erectile Function scores for confidence to achieve erection sufficient for intercourse. An incision was made from anterior superior iliac crest to the glans penis to expose the inguinal canal and ilioinguinal nerve. The ilioinguinal and dorsal penile nerve were transected and anastomosed. The anastomotic site was then wrapped in a hemostatic agent and a drain was left in place. For penile rehabilitation, both patients were instructed to stimulate the penis while looking at the genitalia to encourage redistribution of perceived sensation. Main Outcome Measures: Presence of erogenous penile sensation was tested by neurologic examination and patient feedback, and patients completed sexual health questionnaires. Results: Both patients reported paresthesias of the groin with penile stimulation 1 month after surgery. Both patients are now 24 months postoperative and have erogenous sensation on the ipsilateral glans and shaft during intercourse. Neither patient has difficulty achieving or maintaining erections. Conclusions: We present two patients with dorsal penile reinnervation via the ilioinguinal nerve. Although nerve reinnervation has been used in urological procedures, this is the first description of an attempt to resupply penile sensation via the dorsal penile nerve in the United States with a minimum of 18 months follow-up. Early follow-up suggests successful neuronal remapping and regained sensation of the penis.",
keywords = "Genital Sensation, Ilioinguinal Nerve, Reinnervation, Spina Bifida, Spinal Cord Injury",
author = "Jacobs, {Micah A.} and Avellino, {Anthony M.} and David Shurtleff and Lendvay, {Thomas S.}",
year = "2013",
doi = "10.1111/jsm.12255",
language = "English (US)",
volume = "10",
pages = "2593--2597",
journal = "Journal of Sexual Medicine",
issn = "1743-6095",
publisher = "Wiley-Blackwell",
number = "10",

}

TY - JOUR

T1 - Reinnervating the Penis in Spina Bifida Patients in the United States

T2 - Ilioinguinal-to-Dorsal-Penile Neurorrhaphy in Two Cases

AU - Jacobs, Micah A.

AU - Avellino, Anthony M.

AU - Shurtleff, David

AU - Lendvay, Thomas S.

PY - 2013

Y1 - 2013

N2 - Introduction: Penile sensation is absent in some patients with myelomeningocele owing to the dysfunction of the pudendal nerve. Here, we describe the introduction of penile sensation via ilioinguinal-to-dorsal-penile neurorrhaphy in two patients with penile anesthesia due to neural tube defects. Aim: To establish penile sensation via ilioinguinal-to-dorsal-penile-nerve neurorrhaphy. Methods: A 20-year-old and a 35-year-old male with L5/S1 myelomeningocele were both highly functioning and ambulatory, with intact ilioinguinal nerve distribution sensation but anesthesia of the penis and glans. They were sexually active and able to ejaculate antegrade. Both had high International Index of Erectile Function scores for confidence to achieve erection sufficient for intercourse. An incision was made from anterior superior iliac crest to the glans penis to expose the inguinal canal and ilioinguinal nerve. The ilioinguinal and dorsal penile nerve were transected and anastomosed. The anastomotic site was then wrapped in a hemostatic agent and a drain was left in place. For penile rehabilitation, both patients were instructed to stimulate the penis while looking at the genitalia to encourage redistribution of perceived sensation. Main Outcome Measures: Presence of erogenous penile sensation was tested by neurologic examination and patient feedback, and patients completed sexual health questionnaires. Results: Both patients reported paresthesias of the groin with penile stimulation 1 month after surgery. Both patients are now 24 months postoperative and have erogenous sensation on the ipsilateral glans and shaft during intercourse. Neither patient has difficulty achieving or maintaining erections. Conclusions: We present two patients with dorsal penile reinnervation via the ilioinguinal nerve. Although nerve reinnervation has been used in urological procedures, this is the first description of an attempt to resupply penile sensation via the dorsal penile nerve in the United States with a minimum of 18 months follow-up. Early follow-up suggests successful neuronal remapping and regained sensation of the penis.

AB - Introduction: Penile sensation is absent in some patients with myelomeningocele owing to the dysfunction of the pudendal nerve. Here, we describe the introduction of penile sensation via ilioinguinal-to-dorsal-penile neurorrhaphy in two patients with penile anesthesia due to neural tube defects. Aim: To establish penile sensation via ilioinguinal-to-dorsal-penile-nerve neurorrhaphy. Methods: A 20-year-old and a 35-year-old male with L5/S1 myelomeningocele were both highly functioning and ambulatory, with intact ilioinguinal nerve distribution sensation but anesthesia of the penis and glans. They were sexually active and able to ejaculate antegrade. Both had high International Index of Erectile Function scores for confidence to achieve erection sufficient for intercourse. An incision was made from anterior superior iliac crest to the glans penis to expose the inguinal canal and ilioinguinal nerve. The ilioinguinal and dorsal penile nerve were transected and anastomosed. The anastomotic site was then wrapped in a hemostatic agent and a drain was left in place. For penile rehabilitation, both patients were instructed to stimulate the penis while looking at the genitalia to encourage redistribution of perceived sensation. Main Outcome Measures: Presence of erogenous penile sensation was tested by neurologic examination and patient feedback, and patients completed sexual health questionnaires. Results: Both patients reported paresthesias of the groin with penile stimulation 1 month after surgery. Both patients are now 24 months postoperative and have erogenous sensation on the ipsilateral glans and shaft during intercourse. Neither patient has difficulty achieving or maintaining erections. Conclusions: We present two patients with dorsal penile reinnervation via the ilioinguinal nerve. Although nerve reinnervation has been used in urological procedures, this is the first description of an attempt to resupply penile sensation via the dorsal penile nerve in the United States with a minimum of 18 months follow-up. Early follow-up suggests successful neuronal remapping and regained sensation of the penis.

KW - Genital Sensation

KW - Ilioinguinal Nerve

KW - Reinnervation

KW - Spina Bifida

KW - Spinal Cord Injury

UR - http://www.scopus.com/inward/record.url?scp=84885945983&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84885945983&partnerID=8YFLogxK

U2 - 10.1111/jsm.12255

DO - 10.1111/jsm.12255

M3 - Article

C2 - 23844557

AN - SCOPUS:84885945983

VL - 10

SP - 2593

EP - 2597

JO - Journal of Sexual Medicine

JF - Journal of Sexual Medicine

SN - 1743-6095

IS - 10

ER -